Community Rehabilitation Management

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question as Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People were encouraged and supported to raise safety concerns with the provider. The registered manager and staff understood the importance of reporting safety concerns and learning lessons when things went wrong.

Systems were in place to support staff to report and record safety concerns and events when they arose. The registered manager investigated safety concerns and events and used the learning from these to support staff to continually improve their practice, reduce risk and keep people safe.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The provider had an appropriate process for new referrals, obtaining a copy of the person’s initial assessment, and then carrying out their own assessment of need, before deciding whether they would be able to provide support. There was a paper-based care record system in place, which care staff had access to. This helped ensure people’s care was provided in a planned, responsive and organised way.

People were listened to by the provider’s staff when their initial care plans were being created. This helped ensure people were supported to receive continuity of care when they started receiving care from this service.

The provider had recently updated their key policies and procedures to ensure they reflected best practice in terms of safety and effective ways of working.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt comfortable when staff interacted with them. Staff used respectful language when describing people and their care needs. The provider had a comprehensive safeguarding policy and procedure in place, which included consideration of sexual safety and online safety. Staff received regular safeguarding training.

People also had access to people outside of the service with whom they could raise concerns about their safety if necessary. For example, social workers, other visiting health care professionals, and family members.

The provider carried out investigations into any incidents which occurred while providing a service to people. They also co-operated with safeguarding enquiries carried out by the Local Authority. The provider’s investigation findings were used by the registered manager to identify any lessons learned and actions to be taken to ensure people were protected from abuse.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The provider reviewed any incidents for recurrent trends or triggers. Information was shared with the staff so support arrangements could be changed to reduce recurrences. People were involved in deciding how their individual risks would be managed and mitigated.

People’s individual risks were regularly assessed, and positive risk taking was used as a means of enabling people to maintain as much independence as possible. For example, a person told us, “I like to be very independent, and the care staff have to be up for that. I am usually out every day and I have a dynamic lifestyle!”

People’s care plans detailed how to support them with their complex care and health needs. Staff knew the person they supported well and were aware of the symptoms and cues which might indicate they were becoming unwell or distressed. Staff told us how they supported and encouraged people, enabling them to make their own decisions, rather than trying to control people.

People’s individual risks were identified and assessed in their care plans. Care plans were regularly assessed and amended when people’s needs changed or when they changed how they wanted to receive care from staff.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People were cared for in their own homes. The provider had environmental safety assessments in place to identify any potential risks in the person’s own home which may have a potential impact on the person or their care staff. Any potential environmental concerns were discussed with the person receiving care, as the provider was mindful it was the person’s own home.

The registered manager made sure there were enough qualified, skilled and experienced care staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The registered manager had an effective programme of appropriate staff training in place, and staff told us they received the training they needed to support people safely.

Staff received specific training to ensure they could meet the needs of people with complex care and health needs. This included training related to health conditions, and care needs, experienced by people who have brain and spinal injuries.

The registered manager encouraged staff to develop their skills and knowledge. A staff member told us, “I feel CRM provide a very thorough training package for their staff and ensure all staff are fully competent before allowing them to lead on a shift. This is imperative due to the complexity of care they are delivering as many people are ventilator dependant. Staff are encouraged to identify any training needs they feel they require so that 1:1 support can be given and they are fully confident in their role.”

The registered manager ensured enough suitably trained and experienced staff were rostered on duty to meet people’s assessed care and support needs. When agency staff were required, the provider used regular agency workers who knew the person they would be supporting well. If a new agency worker was required, the provider ensured all new agency workers were introduced to the person they would be supporting. Several shadow shifts were completed by each new agency worker until they were assessed as being able to provide appropriate support to the person.

The provider had robust and safe recruitment practices in place to make sure all staff, including agency staff, were suitably experienced, competent and able to carry out their role.

People were involved in the recruitment of the staff who supported them. This meant each person was able to choose the staff who joined their individual care team. This helped ensure the care team members were suitable to provide support to the person. A person told us, “I am involved in the recruitment of any new staff for my team. I do the meet and greeting, and I then chose the people I wanted to be my staff.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There was an effective approach to assessing and managing the risk of infection, which was in line with current relevant national guidance. The provider had an infection prevention and control (IPC) policy and procedure in place, which staff had access to.

The provider’s IPC policy and procedures set out the clear roles and responsibilities around infection prevention and control. The provider ensured their staff had access to the necessary personal protective equipment (PPE) to support effective hygiene and infection prevention. A staff member told us, “I feel that there is all the equipment needed on site and PPE is plentiful.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People were involved in decisions about their medicines, and their medicines were appropriately prescribed, supplied, stored, and administered in line with the relevant legislation.

People’s prescribed medicines were regularly reviewed by external medical professionals as part of their complex individual health care support.

The provider had appropriate arrangements in place for the safe management, use and oversight of controlled drugs in people’s own homes. People had up-to-date information about their medicines available in their care plans and the provider’s medicine records. The provider worked with people to ensure they had the necessary prescribed medicines available to them. For example, a person told us, “[Registered manager] is amazing at getting me the help I need. If I ever run out of a medicine they are a marvel at finding out where I can quickly get some more supplies from. They are always there to help.”